Quiz Osteopathic Part 2 of 4

Osteopathic Principles & Practice – Part 2

25Mar2009

OPP #1 – Lower Extremities: Knee, Ankle, & Foot 1) Which of the following is an extensor, NOT a flexor of the knee joint? a) Hamstrings (biceps femoris, semitendinosus, semimembranosus) b) Gracilis c) Sartorius d) Popliteus e) Gastrocnemius f) Quadriceps femoris 2) Which of the following is the largest and most complicated articulation in the body? a) Elbow b) Knee c) Ankle d) Wrist e) Foot 3) Regarding the femorotibial joint, the ____ meniscus is semicircular with its anterior end attaching to the anterior intercondylar area in front of the ____ cruciate ligament. a) Lateral; Posterior b) Lateral; Anterior c) Medial; Posterior d) Medial; Anterior 4) The anterior cruciate ligament arises from the ____ and runs backward, upward, and ____ to insert on to the lateral femoral condyle. a) Tibia; Lateral b) Femur; Lateral c) Tibia; Medial d) Femur; Medial 5) The femoropatellar joint is a ____ joint (sellar joint, articulation by reciprocal reception). a) Ball and socket b) Condyloid c) Saddle d) Hinge e) Pivot 6) The posterior cruciate ligament arises from the ____ and runs forward and upward obliquely to insert on to the lateral aspect of the ____ femoral condyle. a) Tibia; Lateral b) Femur; Lateral c) Tibia; Medial d) Femur; Medial 7) Normally, the knee flexes to ____ degrees, with extension being a return from flexion to zero degrees. a) 185 b) 135 c) 85 d) 35 e) 0

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25Mar2009

8) Which of the following is a dorsiflexor, NOT a plantarflexor? a) Gastrocnemius b) Soleus c) Plantaris d) Tibialis anterior e) Flexor hallucis longus 9) Dorsiflexion is normally ____ degrees and plantarflexion is normally ____ degrees. a) 20; 20 b) 50; 50 c) 20; 50 d) 50; 20 e) 90; 90 10) The Anterior Drawer Test (as well as the Lachman Lac hman Maneuver) is used to test which of o f the following ligaments? a) Anterior cruciate ligament (ACL) b) Posterior cruciate ligament (PCL) c) Medial collateral ligament (MCL) d) Lateral collateral ligament (LCL) e) MCL and LCL 11) The Varus-Valgus Stress Test is used to test for which of the following ligaments? a) Anterior cruciate ligament (ACL) b) Posterior cruciate ligament (PCL) c) Medial collateral ligament (MCL) d) Lateral collateral ligament (LCL) e) MCL and LCL 12) The Posterior Drawer Test is used to test which of the following ligaments? a) Anterior cruciate ligament (ACL) b) Posterior cruciate ligament (PCL) c) Medial collateral ligament (MCL) d) Lateral collateral ligament (LCL) e) MCL and LCL 13) Which of the following gives a positive test (failure) if the knee cannot be extended ex tended fully by pulling distally on the leg, indicating fluid within the kne e joint? a) External rotation (Recurvatum Test) b) McMurray test c) Apley Compression Test d) Apley Distraction Test e) Knee Joint Effusion Test (Bounce-Home Test) f) Patella Femoral Grinding Test 14) Which of the following tests uses a valgus stress, adduction, and extension of the leg to evaluate for meniscal tears? a) External rotation (Recurvatum Test) b) McMurray test c) Apley Compression Test d) Apley Distraction Test e) Knee Joint Effusion Test (Bounce-Home Test)

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25Mar2009

f) Patella Femoral Grinding Test 15) Which of the following involves the patient p atient being prone and the clinician pulling distally on the leg and applying torsion to evaluate ev aluate for medial or lateral ligamentous dysfunction? a) External rotation (Recurvatum Test) b) McMurray test c) Apley Compression Test d) Apley Distraction Test e) Knee Joint Effusion Test (Bounce-Home Test) f) Patella Femoral Grinding Test 16) Which of the following involves the patient p atient flexing their quadriceps while the clinician pushes the patella caudad, checking for pain or crepitation to evaluate potential chondromalacia of the patella? a) External rotation (Recurvatum Test) b) McMurray test c) Apley Compression Test d) Apley Distraction Test e) Knee Joint Effusion Test (Bounce-Home Test) f) Patella Femoral Grinding Test 17) Which of the following gives a positive test if the knee hyperextends with external rotation of the tibia, indicating injury to the arcuate ligament, popliteus, and fibular collateral ligaments? a) External rotation (Recurvatum Test) b) McMurray test c) Apley Compression Test d) Apley Distraction Test e) Knee Joint Effusion Test (Bounce-Home Test) f) Patella Femoral Grinding Test 18) Which of the following involves the patient being prone and the clinician pushing downward on the leg and applying torsion to evaluate a medial meniscal tear? a) External rotation (Recurvatum Test) b) McMurray test c) Apley Compression Test d) Apley Distraction Test e) Knee Joint Effusion Test (Bounce-Home Test) f) Patella Femoral Grinding Test 19) Which of the following is most associated with lateral foot pa in? a) Cuboid b) Calcaneus c) Navicular d) Talus 20) The most common type of ankle sprain represents an ____, with the ____ ankle ligaments sustaining the initial impact. a) Eversion; Lateral b) Inversion; Lateral c) Eversion; Medial

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25Mar2009

d) Inversion; Medial 21) The lateral longitudinal arch of the foot involves all of the following bones EXCEPT: a) Cuboid b) Calcaneus c) 3rd metatarsal d) 4th metatarsal e) 5th metatarsal 22) The medial longitudinal arch (spring) of the foot involves all of the following bones EXCEPT: a) Calcaneus b) Talus c) Navicular d) Cuneiforms e) Metatarsals 1-4 23) Which of the following transverse arches of the foot has the five metatarsals as a base? a) Anterior metatarsal arch b) Posterior metatarsal arch c) Tarsal arch OPP #2 – Psoas, Quadratus Lumborum, & Piriformis Syndrome 1) The quadratus lumborum muscle is innervated by all of the following EXCEPT: a) T12 b) L1 c) L2 d) L3 e) L4 2) Referred pain from the quadruatus lumborum, such as during spasm, goes to where? a) Middle of the back b) Right shoulder c) Hip and groin d) Inguinal ligament e) 12th rib 3) Where is the key non-neutral somatic dysfunction in psoas syndrome? a) T11-T12 b) L1-L2 c) L3-L4 d) L5-S1 e) S2-S3 4) If the left psoas is in spasm (left oblique axis of sacrum), which of the following somatic dysfunctions is present? FB = forward bending a) FB RR SR b) FB RR SL c) FB RL SR d) FB RL SL

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25Mar2009

5) The psoas muscle extends over the superior pubic ramus and under the inguinal ligament, inserting on the ____ trocanter on the ____ side of the femur. a) Greater; Medial b) Greater; Lateral c) Lesser; Medial d) Lesser; Lateral 6) What nerves innervate the psoas muscle? a) T12-L1 b) L2-L3 c) L4-L5 d) S1-S2 e) S3-S5 7) Which of the following would most likely cause psoas syndrome? a) Slumping over in a soft chair b) Sitting upright in a hard chair cha ir c) Working at a desk and bending down quickly d) Weeding in a garden and getting up quickly e) Being rear-ended in a car 8) If the left oblique sacral axis is engaged and the spine is neutral (no flexion or extension), there will be a ____ torsion. If the spine is non-neutral, there will be a ____ torsion. a) Right forward; Right backward b) Left forward; Left backward c) Right backward; Right forward d) Left backward; Left forward 9) If the left sacral oblique axis is engaged from a psoas spasm, the sacrum will rotate right giving a shallow ____ sacral sulcus and a prominent ILA on the ____. a) Left; Right b) Right; Left c) Left; Left d) Right; Right 10) Psoas syndrome can cause external rotation of o f the ____ femur with short leg and an d sciatic pain on the ____ side, due to piriformis involvement on that side. a) Ipsilateral; Ispiateral b) Contralateral; Contralateral c) Ipsilateral; Contralateral d) Contralateral; Ipsilateral 11) Stretching of a dysfunctional muscle (e.g. psoas) cou ld induce a reflex spasm and make the dysfunction worse. a) True b) False 12) Which of the following test for the presence of a flexion contracture of the hip? a) Patrick test b) McMurray test c) Apley Test d) Thomas test

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25Mar2009

e) Tinel test 13) The piriformis muscle originates from the anterior portion of the sacrum as well as the sacrotuberous ligament, exits the pelvis through the ____ sciatic foramen, and inserts on the ____ trochanter of the femur. a) Greater; Lesser b) Greater; Greater c) Lesser; Greater d) Lesser; Lesser 14) What percentage of the population p opulation (approximately) has the sciatic nerve passing directly through the piriformis muscle? a) 0-5% b) 10-15% c) 20-25% d) 30-35% e) 40-45% 15) Which of the following is not commonly associated with sciatica? a) Pain down to the calf or foot b) Pain down the posterior thigh c) Buttocks pain d) Hip pain e) Low back pain 16) To test for asymmetry of the piriformis muscle, the clinician would ____ until resistance is felt. a) Internally rotate the hips b) Externally rotate the hips c) Internally rotate the knees d) Externally rotate the knees OPP #3 – Lumbar Muscle Energy 1) Who is credited with developing muscle energy techniques? a) A. T. Still b) P. S. Moran c) N. A. Pruzzo d) F. L. Mitchell, Jr. e) F. L. Mitchell, Sr. 2) What classification is given to muscle energy techniques? a) Direct b) Indirect c) Neutral d) High velocity e) Myofascial 3) Muscle energy techniques ____ muscle fibers and ____ hypertonicity. a) Lengthen; Increase b) Lengthen; Decrease c) Shorten; Increase d) Shorten; Decrease

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25Mar2009

4) Which of the following is defined as immediately following contraction, the neuromuscular apparatus is in a refractory state during which passive stretching may b e performed without encountering strong myotatic reflex opposition? a) Oculocervical (Oculogyric) teflex b) Respiratory assist c) Postisometric relaxation d) Joint mobilization using muscle force e) Reciprocal inhibition 5) Which of the following would involve contraction of an agonist (e.g. biceps) bicep s) to relax the antagonist muscles (e.g. triceps)? a) Oculocervical (Oculogyric) teflex b) Respiratory assist c) Postisometric relaxation d) Joint mobilization using muscle force e) Reciprocal inhibition 6) Which of the following muscle energy contraindications is absolute and not relative? a) Moderate to severe muscle strains b) Advanced osteoporosis c) Severe illness (e.g. myocardial infarction) d) Severe joint instability at treatment site e) Post-surgical patients 7) During muscle energy techniques, the barrier is engaged eng aged ____ the somatic dysfunction diagnosis and the patient contracts ____ the freedom of motion. a) Toward; Into b) Toward; Away from c) Away from; Into d) Away from; Away form 8) Which of the following is the last step in a muscle energy technique? a) Check for somatic dysfunction b) Engage the barrier c) Patient contracts d) Allow for relaxation e) Engage new barrier 9) What vertebral body is located at the level of the iliac crests? a) L1 b) L2 c) L3 d) L4 e) L5 10) Flexion and extension are the major movements of lumbar vertebra as their facets are lined in a ____ direction. a) Backward and medial b) Backward and lateral c) Forward and medial d) Forward and lateral

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25Mar2009

11) Because of the location of o f the latissimus dorsi insertion, hypertonicity in this muscle can yield pain in which location? a) Neck b) Shoulder c) Thoracic spine d) Lumber spine e) Chest 12) Hypertonicity of the gluteus maximus would yield pain in which regions? a) Upper and middle back b) Middle and lower back c) Lower back and gluteals d) Gluteals and thighs e) Thighs and knees 13) Which of the following is NOT an attachment of quadratus lumborum? a) Iliac crest b) Iliolumbar ligament c) Inguinal ligament d) 12th rib 14) What is the action of the iliopsoas (psoas major and iliacus)? a) Extends and internally rotates hip b) Extends and externally rotates hip c) Flexes and internally rotates hip d) Flexes and externally rotates hip 15) Which of the following is the first to become tender with lumbar posture changes, giving a tender area about 1” superior and lateral to the PSIS on the iliac crest? a) Anterior longitudinal ligament b) Posterior longitudinal ligament c) Ligamentum flavum d) Iliolumbar ligament e) Sacroiliac ligament 16) Weakness in which of the following muscles would wou ld cause stress in the lumbar region? a) Abdominal muscles b) Trapezius c) Lattisimus dorsi d) Gluteus maximus e) Hamstrings Match the following types of back pain with possible diagnoses: 17) Pain that wakes the patient from sleep a) Dissecting aortic aneurysm 18) Claudication symptoms with back pain b) Malignancy (tumor) 19) Sudden severe low back pain without trauma c) Epidural abscess 20) Rapidly progressing neurological defects d) Spinal stenosis Match the term with the Fryette mechanics involved: a) Type I b) Type II 21) Flexed or extended 22) Single segment 23) Group segments

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25Mar2009

24) Sidebending and rotation in opposite directions 25) Neutral 26) Sidebending and rotation to same direction 27) Sidebending occurs in which plane of motion? a) Ventral b) Sagittal c) Coronal d) Transverse e) Dorsal 28) When treating lumbar dysfunction with muscle energy, which o f the following positions is the setup for a flexion dysfunction? a) Rotation side up, lateral Sims b) Rotation side up, lateral recumbent c) Rotation side down, lateral Sims d) Rotation side down, lateral recumbent 29) When treating lumbar dysfunction with muscle energy, which o f the following positions is the setup for an extension dysfunction? a) Rotation side up, lateral Sims b) Rotation side up, lateral recumbent c) Rotation side down, lateral Sims d) Rotation side down, lateral recumbent 30) In a type II lumbar extension dysfunction, the clinician would push the patient’s legs ____. In a type I lumbar extension dysfunction, the clinician would push the patient’s legs ____. a) Down; Down b) Down; Up c) Up; Up d) Up; Down 31) Which disease that can cause low back pain is also known kno wn as osteitis deformans? a) Graves disease b) Kawasaki disease c) Alzheimer disease d) Castleman disease e) Paget disease OPP #4 – Sacral Somatic Dysfunction 1) Which of the following does not fit with the rest of the sacral spring test descriptions? a) Positive spring test b) Sacroiliac dysfunction c) Forward sacral dysfunction d) Painful 2) For a forward sacral dysfunction (neutral), if a deep sulcus is found on the left and the inferior lateral angle (ILA) is found posterior on the right, which of the following is the dysfunction? a) Unilateral sacral flexion left b) Unilateral sacral flexion right

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25Mar2009

c) Left on left d) Right on right e) Bilateral sacral flexion 3) For a backward sacral dysfunction (non-neutral), if a shallow sulcus is found on the left and the ILA is posterior on the right, which of the following is the dysfunction? a) Unilateral sacral extension left b) Unilateral sacral extension right c) Left on right d) Right on left e) Bilateral sacral extension 4) Using alternative terminology, what is an anterior sacrum right? a) Sacrum is rotated right and side-bent right b) Sacrum is rotated left and side-bent left c) Sacrum is rotated right and side-bent left d) Sacrum is rotated left and side-bent right 5) What is posterior sacrum left? a) Sacrum is rotated right and side-bent right b) Sacrum is rotated left and side-bent left c) Sacrum is rotated right and side-bent left d) Sacrum is rotated left and side-bent right 6) Which of the following is NOT true with posterior po sterior sacrum left? a) Right psoas spasm and short leg b) Left piriformis spasm c) Pelvic side-shift left d) Pain at left ILA e) Positive seated flexion right 7) Which of the following is true for a right sacral torsion? a) L5 side-bending on right oblique axis, seated flexion test positive on right b) L5 side-bending on right oblique axis, seated flexion test positive on left c) L5 side-bending on left oblique axis, seated flexion test positive on right d) L5 side-bending on left oblique axis, seated flexion test positive on left 8) In a primary care clinic, your next scheduled sched uled patient is complaining about groin pain and headaches. You happen to notice the patient walking down the hall with an abnormal gait and increased lordotic curve. Upon examination, there is no sacral flexion or extension and a positive seated flexion test on the right. What is the diagnosis? a) Sacrum left on left b) Sacrum left on right c) Sacrum right on right d) Sacrum right on left 9) A patient presents with low back pain pa in that they got while bowling. Upon examination, L5 is rotated right. The sacral base has ha s moved posteriorly (right pole). What is the diagnosis? a) Sacrum left on left b) Sacrum left on right c) Sacrum right on right d) Sacrum right on left

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25Mar2009

10) Which of the following is true for a L5 F RR SR somatic dysfunction? a) Left obique axis, sacrum rotates left, seated flexion positive on left b) Right obique axis, sacrum rotates left, seated flexion positive on left c) Right obique axis, sacrum rotates right, seated flexion positive on left d) Right obique axis, sacrum rotates right, seated flexion positive on right e) Right obique axis, sacrum rotates left, seated flexion positive on right 11) Which of the following is true for a L5 N RR SL somatic dysfunction? a) Right obique axis, sacrum rotates left, seated flexion positive on left b) Right obique axis, sacrum rotates right, seated flexion positive on left c) Left obique axis, sacrum rotates left, seated flexion positive on left d) Left obique axis, sacrum rotates right, seated flexion positive on right e) Left obique axis, sacrum rotates left, seated flexion positive on right 12) A patient presents with low back pain p ain shortly after giving birth. An increased lumbar curve is found along with a negative spring test and bilateral posterior ILAs. A bilateral sacral flexion dysfunction is diagnosed. Which sacral axis is being used for motion? a) Vertical axis b) Oblique axis c) Superior transverse axis d) Middle transverse axis e) Anteroposterior axis 13) A patient presents with low back pain p ain that gets worse with forward bending. A bilateral sacral extension dysfunction is diagnosed. Which of the following is true? a) Increased lumbar curve, negative spring test b) Increased lumbar curve, positive spring test c) Decreased lumbar curve, positive spring test d) Decreased lumbar curve, negative spring test 14) In short leg syndrome, the deep sacral sulcus will be on the ipsilateral side. a) True b) False 15) When walking, the thoracic area initially rotates left. Then the lumbar area side-bends left and there is torsional locking at the lumbosacral junction, as the body of the sacrum is moving left. What happens to the vertical center of gravity? a) It moves to the inferior pole of the left SI b) It moves to the superior pole of the left SI c) It moves to the inferior pole of the right SI d) It moves to the superior pole of the right SI 16) When walking, as the right foot moves forward, the quadriceps on that side tense. Which of the following is true? a) There is tension on the inferior pole of the left SI b) There is tension on the superior pole of the left SI c) There is tension on the inferior pole of the right SI d) There is tension on the superior pole po le of the right SI 17) During walking, the innominate moves anterior and posterior on what axis? a) Oblique axis b) Inferior transverse axis c) Superior transverse axis

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25Mar2009

d) Middle transverse axis e) Anteroposterior axis OPP #5 – Thoracic Spine Somatic Dysfunction 1) The kyphotic curve is a primary (fetal) curve with mild, forward bending, that ____ with age, especially in ____. a) Decreases; Men b) Decreases; Women c) Increases; Men d) Increases; Women 2) Surgeons tend to avoid procedures in the area of the thoracic duct due to what other anatomical structure? a) Cisterna chyli b) Ligamentum flavum c) Sympathetic chain d) Esophagus e) Azygous vein 3) Which of the following is NOT a function of the muscle of the thoracic spine? a) Posture b) Breathing c) Anchor for head/neck d) Visceral function e) Gross motion/lifting 4) A patient presents with myofascial pain when rotating or side-bending their neck. The patient has an “uneasy” feeling in their stomach associated with this motion. Which of the following muscles would most likely be involved? a) Splenius cervicis b) Internal oblique c) External oblique d) Erector spinae e) Rotatores 5) The erector spinae group is often associated with ____ mechanics and the rotatores are often associated with ____ mechanics as well as viscerosomatic reflexes. a) Type I; Type I b) Type I; Type II c) Type II; Type I d) Type II; Type II 6) In order to change parasympathetic tone in the thoracic area, what nerve should be affected? a) Phrenic b) Trigeminal c) Vagus d) Facial e) Long thoracic 7) A patient presents after surgery with increased sympathetic tone. Which of the following techniques can be done to normalize sympathetic function?

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25Mar2009

a) Rib-raising b) Cervical HVLA c) Lumbar muscle energy d) Ischial spread e) Pedal pump (Dalrymple Technique) Match the somatovisceral innervation with the associated organ(s): 8) Left colon a) T1-T4 9) Right colon b) T1-T6 10) Heart and lungs c) T5-T9 11) Head and neck d) T10-T11 12) Liver, gall bladder e) T12-L2 13) Pancreas, spleen 14) Stomach, duodenum 15) Uterus, gonads 16) Distal small bowel 17) Pelvic organs 18) What is the major type of motion in the upper thoracic vertebra? a) Flexion b) Extension c) Rotation d) Side-bending 19) What is the major type of motion in the lower thoracic vertebra? a) Flexion b) Extension c) Rotation d) Side-bending 20) What direction do the cervical facets face ts face? a) Backward, upward, medial b) Backward, upward, lateral c) Backward, medial d) Backward, lateral 21) What direction do the thoracic facets face ts face? a) Backward, upward, medial b) Backward, upward, lateral c) Backward, medial d) Backward, lateral 22) What direction do the lumbar facets face? face ? a) Backward, upward, medial b) Backward, upward, lateral c) Backward, medial d) Backward, lateral Match the type of Freyette mechanics with the thoracic vertebrae: 23) T1-T4 (upper) a) Type I 24) T5-T7 (middle) b) Type II 25) T8-T11 (lower) c) Mixed Type I, Type II 26) T12

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27) A 21-year-old male patient presents with a deformed sternum and desire to have cosmetic surgery. It appears that the sternum is sunken into the chest and exam reveals scoliosis. History reveals cardiac and respiratory problems. A CT scan is ordered to obtain a Haller index prior to performing a surgical Nuss procedure. Which of the following does this patient have? a) Pectus excavatum b) Pectus carinatum c) Marfan Syndrome d) Poland Syndrome e) Morquito Syndrome Match the vertebral levels with the anatomical location: 28) Inferior scapular angle a) T2 29) Scapular spine b) T3 30) Xiphosternal angle c) T4 31) Sternal notch d) T7 32) Sternal angle e) T9 33) Which of the following is a palpatory feature of acute somatic dysfunction? a) Cold b) Dry c) Stringy d) Boggy e) Ropey 34) A patient presents with pulmonary problems. When testing for somatic dysfunction, you find that the chest rises evenly during inhalation. However, during exhalation the right side drops normally and the left side is delayed. You find that ribs 2-6 are involved. What rib is the key rib for manipulative treatment? a) Left rib 2 b) Right rib 2 c) Left rib 6 d) Right rib 6 35) What ribs produce mostly bucket handle motion? a) 1, 2, 10, 11, 12 b) 11-12 c) 1-6 d) 7-10 e) 3-5 36) Which of the following is NOT involved in typical osteopathic treatment? a) Medications b) Medical procedures c) Surgery d) OMT e) Acupuncture 37) Which of the following is considered a typical rib? a) 1 b) 9 c) 10

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d) 11 e) 12 38) The diaphragm is responsible for at least what percentage of change in pressure within the thoracic cage? a) 20% b) 40% c) 60% d) 80% e) 100% 39) A patient is being treated for 11-12 rib exhalation somatic dysfunction. During inhalation, the physician instructs the patient to pull the right ASIS down toward the table while the physician’s right hand resists. At the same time, the left hand exaggerates the inhalation motion be exerting force in what directions? a) Medial b) Lateral c) Lateral and caudad d) Lateral and cephalad e) Medial and caudad 40) A patient presents with shortness of breath. Examination reveals 7 th rib exhalation dysfunction. Which of the following should be used to treat this patient? a) Serratus anterior, long thoracic nerve b) Serratus anterior, medial pectoral nerve c) Pectoralis minor, medial pectoral nerve d) Latissimus dorsi, thoracodorsal nerve e) Pectoralis minor, thoracodorsal nerve Match the ribs with their muscular attachments: 41) Ribs 6-8 a) Posterior scalene 42) Rib 1 b) Anterior/middle scalenes 43) Rib 2 c) Pectoralis minor 44) Rib 12 d) Quadratus lumborum 45) Ribs 3-5 e) Latissimus dorsi 46) Ribs 9-11 f) Serratus anterior OPP #6 – Self Esteem & “Healer’s Touch” 1) Secondary self esteem is described as: a) Perceived successes and achievements b) Perception of one’s value from significant others c) Positive physical appearance and high value d) Achievements and abilities 2) Which of the following would be used to describe the dialogue, “I am not going to be a good doctor because I do not know as much as Dr. Jan. I might as well give up now.” a) Overly self critical b) Overgeneralization c) Looking glass self d) Catastrophizing

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3) Which of the following relationship pillars involves opening up to risks and vulnerabilities and can result in indifference, rejection, or betrayal? a) Self-disclosure b) Need fulfillment c) Commitment ability d) Conflict management e) Commutation 4) Which of the following can be described in the Vince Lombardi quote, “The harder you work, the harder it is to surrender?” a) Conflict management b) Need fulfillment c) Commutation d) Self-disclosure e) Commitment ability 5) Which of the following is an example of healthy conflict, which does not bring about the issues of power and control? a) Double standards b) Motivation to participate c) Economic inequities d) Intimidation and name calling e) Manipulation or isolation 6) If a clinician is talking with a patient, but the clinician does not have ha ve enough selfesteem to give their opinion, what communication c ommunication role are they taking? a) Parent b) Adult c) Child 7) Relationships with others are primarily: a) Altruistic b) Demanding c) Love-inducing d) Need-based e) Wanting 8) Which of the following involves the ends en ds justifying the means and may lead to retaliation? a) Win-win collaboration b) Compromise c) Lose-win collaboration d) Win-lose collaboration e) No winners, no losers 9) Which of the following can be described as “discretion being the better part of valor?” va lor?” a) Win-win collaboration b) Compromise c) Lose-win collaboration d) Win-lose collaboration e) No winners, no losers

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25Mar2009

10) A word someone might use to describe how they feel about two unrelated things that elicit very different emotions is: a) Anger b) Fear c) Happy d) Love e) Sad 11) In order to ensure that the receiver of a message understand what is meant, which of the following must take place? a) Appreciation b) Back talk c) Collaboration d) One-way communication e) Reflective listening 12) Effective physician-patient communication has been associated with reduc ed risk of malpractice lawsuits. a) True b) False, lawsuits always depends on whether malpractice took place 13) Which of the following is a new field of medicine involving psychoneuroimmunology? a) The power of the mind b) Guided imagery c) Meditation d) Shamanism e) Hypnosis 14) Which of the following is recognized as a door to the unconscious unc onscious mind and was first called “animal magnetism” by Franz Anton Mesmer? a) The power of the mind b) Guided imagery c) Meditation d) Shamanism e) Hypnosis 15) Which of the following is a way to calm the mind and body and has been defined by some as “listening to God.” a) The power of the mind b) Guided imagery c) Meditation d) Shamanism e) Hypnosis 16) Which of the following has been described by Dr. Martin Rossman as “a window to your inner world” and involves communication between emotion and bodily change? a) The power of the mind b) Guided imagery c) Meditation d) Shamanism e) Hypnosis

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25Mar2009

17) Which of the following is an alternative approach a pproach in which the “mind and an d spirit can be awakened?” a) The power of the mind b) Guided imagery c) Meditation d) Shamanism e) Hypnosis 18) Which of the following people has h as written on the effects of spirituality, prayer, and the healing process as well as conducting condu cting double-blind studies on these topics? a) Padre Pio b) Martin Rossman, MD c) Larry Dossey, MD d) Benedict Lust e) John Upledger, DO f) Jan Hendryx, DO 19) In the book “Healer’s Touch,” by Jan Hendryx, DO, the author suggests adding add ing an additional year of medical school and shifting focus away a way from which of the following courses? a) Manipulative medicine b) Biochemistry c) Anatomy d) Physiology e) Pharmacology 20) What technique was created by Dr. Upledger, DO and Dr. Rossman, MD? a) Muscle energy b) Cranial osteopathy c) HVLA manipulation d) Somatoemotional release e) Creative visualization and guided imagery 21) In the book “Healer’s Touch,” by Jan Hendryx, DO, A.T. Still says the human being is composed of all of the following EXCEPT: a) Mind b) Body c) Spirit d) DNA 22) What is the underlying commonality of all neurotic disorders, such a s OCD, phobias, and anxiety? a) Anger b) Fear c) Happiness d) Love e) Sadness 23) Which of the following is NOT a defense mechanism described by Sigmund Freud in regard to Western ego (fear-based reality)? a) Acceptance b) Denial

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c) Distortion d) Repression e) Projection 24) Andrew Jackson Davis expressed that the root cause of all illness begins with the: a) Mind b) Body c) Spirit OPP #7 – Relaxation Techniques 1) Which of the following is NOT a benefit of relaxation? a) Restorative energy b) Decrease distressing reactions c) Creates a receptive mental and physical state d) Prepares the body and mind for activity e) Increases sympathetic tone 2) Which of the following, described by J. H. Schultz, is described as a relaxation state of feeling “warmth” and “heaviness”? a) Functional relaxation b) Autogenic relaxation c) Progressive muscle relaxation d) Jacobsonian relaxation e) Fantasy 3) Which of the following involves tensing a muscle group tightly and holding, then going limp and repeating with another muscle group? a) Functional relaxation b) Autogenic relaxation c) Progressive muscle relaxation d) Jacobsonian relaxation e) Fantasy 4) Which of the following is the only human act that can be done don e either completely consciously or unconsciously? a) Walking b) Thinking c) Breathing d) Smelling e) Hearing 5) One-third of people breathe ineffectively, which can lead to: a) Cardiovascular disorders b) Mood disorders c) Immune disorders d) Digestive problems e) All of the above 6) Which of the following is a Sanskrit term for universal life force or breath, which can be enhanced by yoga? a) Pneuma b) Prana

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c) Anima spiritus d) Ki e) Rauch 7) The “Relaxing Breath” exercise for breathing involves breathing in for ____ seconds, holding the breath for ____ seconds, and breathing out over ____ seconds in an attempt to calm the sympathetic nervous system. a) 2; 3; 4 b) 3; 6; 9 c) 4; 7; 8 d) 4; 6; 11 e) 7; 4; 8 8) Which of the following exercises involves flexing a muscle group then slowly releasing the tension, which usually starts from the cephalad muscles going down to the caudad muscles? a) Functional relaxation b) Autogenic relaxation c) Progressive muscle relaxation d) Jacobsonian relaxation e) Fantasy 9) Rehearsal is important in which of the following techniques? a) Functional relaxation b) Autogenic relaxation c) Progressive muscle relaxation d) Jacobsonian relaxation e) Fantasy 10) Which of the following would involve picturing oneself in a tranquil environment with positive surroundings to promote relaxation? a) Autogenic relaxation b) Guided imagery c) Jacobsonian relaxation d) Shamanism e) Hypnosis OPP #8 – Meditation 1) Which of the following is described as focusing the mind and paying attention? a) Autogenic relaxation b) Guided imagery c) Jacobsonian relaxation d) Meditation e) Hypnosis 2) Benson (1975) developed which of the following? a) Transcendental Meditation (TM) b) Clinically Standardized Meditation (CSM) c) Respiratory One Method (ROM) d) Tai Chi e) Zen Meditation

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3) Which of the following was developed by Carrington, et. al. (1978)? a) Transcendental Meditation (TM) b) Clinically Standardized Meditation (CSM) c) Respiratory One Method (ROM) d) Mindfulness Meditation e) Zen Meditation 4) Which of the following would be helpful for children who have difficulty sitting still? a) Transcendental Meditation (TM) b) Clinically Standardized Meditation (CSM) c) Respiratory One Method (ROM) d) Mindfulness Meditation e) Zen Meditation 5) Which of the following is a sound or phrase that is repeated verbally or silently that focuses the mind and allows one to enter into and remain in a meditative state? a) Chant b) Word c) Prayer d) Saying e) Mantra 6) Which of the following is NOT true of the effects of meditation? a) Increased sympathetic activity b) Increased alpha (8-14 Hz) and theta (5-7 Hz) brainwave activity c) Decreased beta (15-25 Hz) brainwave activity d) Decreased blood lactate (stress) e) Increased Dehydroepiandrosterone Sulfate (DHEA-S) 7) Which of the following is NOT true of the effects of meditation? a) Balances autonomic nervous system b) Decreases pain c) Increase use of addictive substances d) Improves mood disorders e) Reduces blood pressure 8) During meditation, the focus should be on: a) Improving delta brainwaves b) Keeping your eyes closed c) Breathing d) Fantasizing e) Departing from your body OPP #9 – Facilitated Positional Releases 1) Who developed Facilitated Positional Release (FPR) in 1990, termed “instant osteopathy?” a) A. T. Still b) S. Schiowitz c) E. DiGiovanna d) F. L. Mitchell, Jr. e) F. L. Mitchell, Sr.

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2) FPR is a(n) ____ myofascial technique with treatment taking ____ second(s). a) Direct; 1 b) Indirect; 1 c) Direct; 3-5 d) Indirect; 3-5 3) Which of the following is considered a relative, not absolute contraindication for FPR? a) Metastatic cancer b) Cervical joint instability c) Ankylosing spondylitis d) Herniated disc e) Cervical fracture 4) What is the physiological goal of FPR? a) Increase discharge rate of type 1a sensory fibers (muscle spindle) b) Stop discharge from type 1a sensory fibers (muscle spindle) c) Increase discharge rate of type 1b sensory fibers (Golgi tendon organ) d) Stop discharge from type 1b sensory fibers (Golgi tendon organ) o rgan) 5) Before a compressive force is used, how should the cervical spine be positioned for FPR? a) Rotated toward dysfunction b) Rotated away from dysfunction c) Sidebent toward dysfunction d) Sidebent away from dysfunction e) Neutral 6) A patient presents with numbness in their lateral forearm, thumb, and index finger. What nerve root is involved? a) C5 b) C6 c) C7 d) C8 e) T1 7) A patient presents with a diminished triceps reflex. What nerve root is involved? a) C5 b) C6 c) C7 d) C8 e) T1 8) When using the Spurling test for cervical radiculopathy radiculopa thy secondary to nerve root compression, how should the test be performed? a) Extend neck, sidebend to side of pain, compress head b) Extend neck, sidebend away from side of pain, compress head c) Flex neck, sidebend to side of pain, compress head d) Flex neck, sidebend to side of pain, add traction to head e) Flex neck, sidebend away from side of pain, rotate toward side of pain 9) The Wallenberg test involves having the patient flex, extend, and rotate their head at intervals of 10 seconds while checking for light-headedness, nystagmus, or visual changes. What does this test for?

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a) Nerve root lesion b) Cervical radiculopathy c) Vertebral artery insufficiency d) Cervical thrombi or blocked lymph flow e) Seizure disorders 10) During a muscle strength test, which of the following is described as movement against gravity without resistance? a) 1 of 5 b) 2 of 5 c) 3 of 5 d) 4 of 5 e) 5 of 5 11) A patient presents with an upper motor neuron (UMN) lesion due to a stroke. Deep tendon reflexes show sustained clonus, a grading of: a) +0 of 4 b) +1 of 4 c) +3 of 4 d) +3 of 4 e) +4 of 4 12) Damage to the C5 nerve root would show weakness in which of the following? a) Interossei b) Triceps brachii c) Biceps brachii d) Deltoid e) Finger flexion 13) Which of the following is NOT one of the National Emergency X-Radiography Utilization Study (NEXUS) Low Risk Criteria (NLC) for ruling out spinal x-ray? a) No posterior midline cervical-spine tenderness b) No evidence of intoxication c) Altered level of alertness d) No focal neurologic deficit e) No painful distracting injuries OPP #10 – Nutrition 1) Females are how much more likely to die of heart disease than breast cancer? c ancer? a) 2x b) 3x c) 4x d) 8x e) 24x 2) What is the third leading cause of o f death (2008) in the United States? a) Cardiovascular b) Cancer c) Iatrogenic d) Malnutrition e) Obesity

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3) The “Typical American Diet” is high in which of the following? a) Fiber b) Protein c) Calcium d) Potassium e) Vitamins 4) Which of the following is NOT characteristic of a plant-based diet? a) Decreased cholesterol b) Protects against coronary artery disease c) Protects against cancer d) Protects against chronic disease e) Prevents alkaline and crystal urine when taking high doses of ciprofloxacin 5) Which of the following would more likely be seen in an affluent population? a) Cancer b) Tubeculosis c) Parasites d) Pneumonia e) Rheumatic heart disease 6) In the Indian Aflatoxin Study, rats were fed aflatoxin ( Aspergillus mycotoxin) as part of their diet. The incidence of liver cancer increased from 0% to 100% when which substance in the rat’s diet was increased from 5% to 20%? a) Protein b) Fat c) Sodium d) Calcium e) Growth hormone 7) Foci response would be the greatest in a diet consisting of what type of protein? a) 20% casein b) 20% gluten c) 5% casein d) 5% gluten e) 5% gluten, 5% casein 8) Adequate protein for body growth consists of what percentage of daily calories? a) 4% b) 6% c) 8% d) 10% e) 12% f) 14% g) 20% OPP #11 – High Velocity Low Amplitude Thrust Technique 1) Which of the following did A. T. Still stress to his students? a) Memorizing his techniques b) Understanding pharmacology c) Understanding anatomy

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d) Understanding biochemistry e) Being compassionate 2) The cavitation theory describes the HVLA mechanism as: a) Change in lymphatic fluid to a gaseous state b) Change in circulatory fluid to a gaseous state c) Change in synovial fluid to a gaseous state d) Movement of trapped air from inside the vertebral disks e) The presence of a linear radiolucency in the disk space 3) The presence of a cracking or popping sound during HVLA treatment treatment is indicative of successful treatment. a) True b) False 4) HVLA is considered what type of technique? a) Active and direct b) Active and indirect c) Passive and indirect d) Passive and direct 5) Proper force during HVLA is in the direction of normal spinal motion (flex/extend or side-bend). a) True b) False, an oblique force is used u sed 6) The action applied during HVLA is a “forceful thrust.” a) True b) False, the force is a “nudge” 7) Which of the following complications has been associated with cervical manipulation, with hyperextension seeming to be associated? a) Nerve root lesion b) Cervical radiculopathy c) Vertebral artery insufficiency d) Blocked lymph flow e) Vertebral basilar thrombosis 8) Dens dislocation due to rupture or laxity of the transverse ligament of the atlas is associated with which of the following? a) Down syndrome b) Marfan syndrome c) Beçhet disease d) Kienbock disease e) Wolff-Parkinson-White syndrome 9) Which of the following is true of the occipitoatlantal (OA) joint? a) Type I mechanics b) Type II mechanics c) Type I-like mechanics d) Type II-like mechanics 10) While palpating the articular pillars of a patient, you feel your left hand go in deeper d eeper at the level of C3. The depth evens out with extension. Which of the following is true? a) C3 E SBR RR

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b) C3 E SBR RL c) C3 E SBL RR d) C3 E SBL RL e) C3 F SBR RR OPP #12 – Cervical HVLA Match the following Osteopathic events with their date: 1) Death of A.T. Still a) 1828 2) The California Experience b) 1874 3) A.T. Still “flung “flung the banner of osteopathy to the breeze” c) 1892 4) American School of Osteopathy opens in Kirksville d) 1917 5) Birth of A.T. Still e) 1961 6) When palpating down (caudad) from the occiput posteriorly, what is the first vertebral spinous process that can be felt? a) C1 b) C2 c) C3 d) C7 e) T1 7) What is the primary motion of the occipitoatlantal joint? a) Rotation b) Flexion-extension c) Side-bending d) Lateral translatory 8) Which of the following motions would narrow intervertebral foramen a nd thus help recreate a cervical radiculopathy? a) Side-bending b) Rotation c) Flexion d) Extension e) Lateral translatory 9) The joints of Luschka (unciform joints) are developed at age 8 to 10 years and are meant to prevent subluxation by limiting what type of motion? a) Side-bending b) Rotation c) Flexion d) Extension e) Lateral translatory 10) What vertebral process should be monitored when doing gross motion testing of the cervical spine for flexion and extension? a) C1 b) C2 c) C3 d) C7 e) T1 f) None of the above

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11) During OA examination, the left sulcus is felt dee per than the right and its depth dep th increases with flexion. The two sulci are most symmetrical in extension of the occiput. What is the diagnosis? a) OA F RR SBL b) OA E RR SBL c) OA F RL SBR d) OA E RL SBR 12) Which of the following procedures would correctly diagnosis an atlantoaxial (AA) joint rotated right somatic dysfunction? a) Flex patient’s head 45 degrees, rotate both directions with restriction found on patient’s left side b) Flex patient’s head 45 degrees, d egrees, rotate both directions with restriction found on patient’s right side c) Maintain patient’s head in a neutral ne utral position, rotate both directions with restriction found on patient’s left side d) Maintain patient’s head in a neutral ne utral position, rotate both directions with restriction found on patient’s right side 13) If the posteriorly rotated articular pillar of C4 was palpated on the right and the rotation became worse in flexion and more symmetrical in extension, what would be the diagnosis? a) C4 F RL SBL b) C4 E RL SBL c) C4 F RR SBR d) C4 E RR SBR 14) When doing high velocity low amplitude (HVLA) thrusting techniques of the cervical spine, which of the following types of motion should never be used as a set-up prior to, or during a technique? a) Flexion b) Extension c) Rotation d) Side-bending e) Distraction 15) If a patient is found to have ha ve an OA E SBL RR dysfunction, what general direction would the thrusting motion be performed during HVLA treatment? a) Sidebending to the left b) Sidebending to the right c) Rotation to the left d) Rotation to the right e) Extension 16) During HVLA treatment of the OA joint, where whe re should the thrusting force be directed towards? a) Ipsilateral ASIS b) Contralateral ASIS c) Ipsilateral shoulder d) Contralateral shoulder e) Ipsilateral eye

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f) Contralateral eye 17) During cervical spine thrusting maneuvers, the clinician should use what part of their hand to monitor the dysfunctional joint? a) Carpometacarpal (CMC) b) Metacarpophalangeal (MCP) c) Proximal interphalangeal (PIP) d) Distal interphalangeal (DIP) 18) What type of thrusting motion is commonly used for HVLA o f the AA joint as well as the typical cervical vertebrae (C3-C7)? a) Flexion b) Extension c) Rotation d) Side-bending e) Distraction OPP #13 – Lumbar & Cervical HVLA + Review of Sacral & Pelvic Diagnosis 1) In the standard thrusting (HVLA) technique for treating lumbar somatic dysfunction (e.g. “Lumbar Roll”), the patient is placed in a lateral recumbent position with the posteriorly rotated transverse process facing ____ and the top foot ____. a) Up; In the popliteal fossa b) Down; In the popliteal fossa c) Up; Off the table d) Down; Off the table 2) Which of the following best describes the thrust used during the standard lumbar HVLA technique? a) The chest is rotated toward the clinician b) The chest is rotated away from the clinician c) The hip is rotated toward the clinician d) The hip is rotated away from the clinician 3) Which of the following lists the minimal testing needed for sacral diagnosis? a) Deep sulcus and Stork test b) Deep sulcus and posterior ILA c) Deep sulcus, posterior ILA, and spring test d) Spring test and posterior ILA e) Spring test, Stork test, deep sulcus, and posterior ILA 4) A standing flexion test is performed on a patient and it is positive on the right. A seated flexion test reveals no change between posterior superior iliac spines (PSIS). Which of the following best describes the dysfunction? a) Right innominate dysfunction b) Right sacral dysfunction c) Right innominate dysfunction with possible sacral dysfunction d) Right sacral dysfunction with possible innominate dysfunction e) No somatic dysfunction 5) During innominate examination, the left ASIS is found to be lower than the right, the right PSIS is found to be higher than the left, and the left pubic tubercle is found to be caudad. Which of the following best describes the dysfunction?

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a) Left anterior (rotated) innominate b) Left posterior (rotated) innominate c) Left superior shear d) Right superior shear e) Right posterior (rotated) innominate 6) In the thrusting (HVLA) technique for treating sacral somatic dysfunction that is similar to lumber HVLA (e.g. “sacral L6”), the patient is placed in a lateral recumbent position with the posteriorly rotated transverse process facing ____ and the top foot ____. a) Up; In the popliteal fossa b) Down; In the popliteal fossa c) Up; Off the table d) Down; Off the table 7) In the sacral “C” HVLA technique (“sacral smiley” or “Chicago technique”), the patient is placed supine with the shallow sulcus facing ____ the clinician and the patient’s hip slid ____ the clinician. a) Toward; Toward b) Toward; Away from c) Away from; Away from d) Away from; Toward OPP #14 – Thoracic & Rib HVLA 1) In the standard thrusting (HVLA) technique for thoracic dysfunction (e.g. “Kirksville Krunch”), the clinician places their ____ directly posterior to the patient’s ____. a) Knuckles; Spinous processes b) Knuckles; Transverse processes c) Thenar eminence; Spinous processes d) Thenar eminence; Transverse processes 2) When doing the standard thrusting technique for a patient who has T4-T6 RR SBL, the clinician would be on the ____ side of the patient and the patient’s arms would be crossed with their ____ arm placed more cephalad. a) Left; Left b) Right; Left c) Left; Right d) Right; Right 3) In the thrusting (HVLA) technique for treating T12 somatic dysfunction that is similar to lumber HVLA, the patient is placed in a lateral recumbent position with the posteriorly p osteriorly rotated transverse process facing ____ and the top foot ____. a) Up; In the popliteal fossa b) Down; In the popliteal fossa c) Up; Off the table d) Down; Off the table 4) Translation of the rib cage can best be used to diagnose which of the following? a) T12 rotation b) T12 side-bending c) L1 rotation d) L1 side-bending

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5) Thoracic vertebra T12, like the rest of the lower thoracic vertebral processes, follows type I mechanics. a) True b) False, T12 follows type II mechanics c) False, lower thoracic vertebral processes follow type II mechanics 6) In the prone thoracic thrusting (HVLA) technique (e.g. “Texas Twist”), the clinician places their hands on the ipsilateral side of the ____ diagnosis with the hand facing ____. a) Rotational; Cephalad b) Rotational; Caudad c) Side-bending; Cephalad d) Side-bending; Caudad 7) Where is the prone thoracic thrusting technique the least effective? a) T1-T3 b) T4-T6 c) T7-T9 d) T10-T12 e) T12 8) HVLA of a posterior rib is most similar to which of the following? a) Prone thoracic thrusting technique b) Standard thoracic thrusting technique c) Standard lumbar thrusting technique d) Sacral C thrusting technique e) T12 thrusting technique f) Seated thoracic thrusting technique 9) In the thrusting (HVLA) technique for a raised first rib, the c linician uses their ____ metacarpophalangeal joint to apply a ____ thrust. a) Contralateral; Rotational b) Contralateral; Downward c) Ipsilateral; Rotational d) Ipsilateral; Downward 10) In the thrusting technique for a raised rib, the patient places their contralateral arm over the clinician’s knee and sidebends sideben ds their body away from the side of the raised rib. The clinician then side-bends the patient’s head ____ the raised rib and rotates the head ____ the raised rib. a) Toward; Toward b) Toward; Away from c) Away from; Away from d) Away from; Toward 11) When treating thoracic inlet dysfunction with a raised rib u sing HVLA, the side bending aspect is treated on the ____ side by thrusting toward the ____, and the rotational aspect is treated on the ____ side by thrusting toward the ____. a) Contralateral; Contralateral ASIS; Ipsilateral; Contralateral shoulder b) Ipsilateral; Contralateral ASIS; Contralateral; Contralateral shoulder c) Contralateral; Contralateral shoulder; Ipsilateral; Contralateral ASIS d) Ipsilateral; Contralateral shoulder; Contralateral; Contralateral ASIS

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OPP #15 – Lumbar, Pelvic, & Sacral HVLA 1) In the standard technique for treating an a n anterior iliac dysfunction, the patient is placed with the dysfunction side up and their top foot ____. A thrusting force is applied ____ to the long axis of the femur. a) In the popliteal fossa; Perpendicular b) In the popliteal fossa; Parallel c) Off the table; Perpendicular d) Off the table; Parallel 2) In the standard technique for treating a posterior iliac dysfunction, the patient is placed with the dysfunction side up and their top foot ____. A thrusting force is applied ____ _ ___ to the long axis of the femur. a) In the popliteal fossa; Perpendicular b) In the popliteal fossa; Parallel c) Off the table; Perpendicular d) Off the table; Parallel 3) In the leg pull technique (HVLA) for iliosacral dysfunction, placing the patient prone and elevating the right leg off the table would be the set-up to treat what type of dysfunction? a) Superior shear b) Anterior (rotated) innominate c) Posterior (rotated) innominate d) Left on left sacrum e) Right on left sacrum 4) In the leg-pull technique for iliosacral dysfunction, placing the patient supine and dropping the left leg off the table would be the set-up to treat what type of dysfunction? a) Superior shear b) Anterior (rotated) innominate c) Posterior (rotated) innominate d) Left on left sacrum e) Right on left sacrum f) Right on right sacrum 5) When treating pubic restriction with a thrusting (HVLA) technique, the patient is placed in what position? a) Supine with legs flexed, adducted, addu cted, and internally rotated b) Prone with legs flexed, abducted, and externally rotated c) Supine with legs flexed, abducted, abdu cted, and internally rotated d) Prone with legs flexed, adducted, and internally rotated e) Supine with legs flexed, abducted, and externally rotated OPP #16 – Extremity HVLA 1) When treating the commonly seen case of posterior (dorsal) carpal dysfunction with HVLA, the wrist is placed in ____ and a nd the thrust is performed by pushing ____. a) Hyperflexion; Downward b) Hyperextension; Downward c) Hyperflexion; Upward d) Hyperextension; Upward

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2) If a patient loses the ability to passively supinate, this dysfunction can b e named: a) Anterior radial head or supination dysfunction b) Posterior radial head or supination dysfunction c) Anterior radial head or pronation dysfunction d) Posterior radial head or pronation dysfunction 3) If a patient falls forward onto an outstretch hand, hand , what type of dysfunction will most likely occur? a) Anterior radial head b) Posterior radial head 4) When treating a posterior radial head with a thrusting (HVLA) technique, the patient’s arm is ____ and ____ during the thrusting. a) Pronated; Hyperflexed b) Pronated; Hyperextended c) Supinated; Hyperflexed d) Supinated; Hyperextended 5) When treating a posterior tibial head, the patient is placed in a ____ position and the ____ of the patient’s foot is placed on the physician’s shoulder. a) Prone; Sole b) Prone; Dorsum c) Supine; Sole d) Supine; Dorsum 6) What is the normal range of motion for flexion of the knee joint? a) 10 degrees b) 75 degrees c) 90 degrees d) 115 degrees e) 135 degrees 7) Which of the following describes a condition where the knees are bent inward toward each other (“knock-knees”)? a) Genu valgus b) Genu varus c) Genu recurvatum 8) When treating an anterior fibular head dysfunction with HVLA, the leg is ____ rotated and the thrust is performed downward and outward during ____. a) Externally; Flexion b) Externally; Extension c) Internally; Flexion d) Internally; Extension 9) Loss of dorsiflexion of the foot would be diagnosed as: a) Anterior talus dysfunction b) Posterior cuboid dysfunction c) Anterior tibia dysfunction d) Posterior fibula dysfunction 10) A patient presents with pain on the lateral plantar aspect of the foot proximal to the styloid process of the fifth metatarsal with pain upon inversion. Which of the following is most likely?

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a) Talus dysfunction b) Navicular dysfunction c) Cuboid dysfunction d) Cuneiform dysfunction e) Tarsal dysfunction 11) If a patient presents with a dysfunction of the tibia being posterior on the talus, the clinician would thrust in what direction for an HVLA technique? a) Plantarflexion b) Dorsiflexion 12) When treating cuboid dysfunction with HVLA, the thrust or “whip” is done in: a) Dorsiflexion b) Plantarflexion Match the joint with the range of motion: 13) Dorsiflexion a) 5 degrees 14) Plantarflexion b) 10 degrees 15) Subtalar inversion c) 20 degrees 16) Subtalar eversion d) 50 degrees 17) Forefoot adduction 18) Forefoot abduction OPP #17 – Counterstrain Principles & Thorax 1) The neuromusculoskeletal system accounts for what percentage of the total body? a) 35% b) 50% c) 60% d) 70% e) 80% 2) In what year did A. T. Still “flung the banner of osteopathy to the breeze?” a) 1872 b) 1874 c) 1876 d) 1878 e) 1828 Match the following to the dysfunction: 3.1) T3-5 NSrRl a) Type I 3.2) L5 FSrRr b) Type II 3.3) T7 NSlRr c) Type III 3.4) L3-5 FSlRr d) Not a physiologic motion 3.5) T2-8 NSlRr 3.6) Occurs in extreme flexion or extension 3.7) Usually found at the apex of a group curve 3.8) Usually due to contracted large muscles 3.9) Movement in one plane limits movement in another 4) Which of Fryette’s Principles applies to the cervical spine? a) Type I b) Type II

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c) Type III d) Type I and Type II e) Type I, Type II, and Type III 5) An epidemic of which of the following diseases took the lives of three of A. T. Still’s children? a) Cholera b) Influenza c) Smallpox d) Meningitis e) Typhoid Fever 6) As a general rule, counterstrain tender points are: a) Treated in flexion for the posterior tender points b) Treated in extension for the posterior tender points c) Too tender to palpate d) Too numerous to count e) Located on the anterior part of the body only 7) Counterstrain was discovered accidentally by which of the following? a) A. T. Still b) Eileen DiGiovanna c) Fred Mitchell, Jr. d) Fred Mitchell, Sr. e) Lawrence Jones A 32-year-old female presents to your office with a chief complaint of pain in her chest following a hard day of lifting work. She denies shortness of breath, chest pressure, or diaphoresis. You examine her and locate a tender point on the sternum at the level of the junction of the second rib. 8.1) This represents which anterior counterstrain tender point? a) T1 b) T2 c) T3 d) T4 e) T5 8.2) The tender point would be treated in which position? a) Cervical flexion to the shoulders b) Shoulder abduction and internal rotation c) Slight cervical extension d) Slight cervical flexion e) Shoulder abduction and external rotation 8.3) As you palpate this patient, you feel the first layer, which blends with the skin. This is which layer? a) Superficial fascia b) Deep fascia c) Dura d) Subserous fascia

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8.4) You examine her further and find a tender point halfway between the shoulder and the neck, posterior to the trapezius. You decide to use counterstrain. In which position would you place the patient? a) Shoulder abducted and externally rotated b) Shoulder abducted and internally rotated c) Shoulder extended and externally rotated d) Shoulder extended and internally rotated 8.5) The fascia around the trapezius muscle is: a) Superficial fascia b) Deep fascia c) Dura d) Subserous fascia 8.6) The proper way to perform the procedure on this patient would be: a) Leave the patient for a half hour while the body corrects itself b) Hold for 90 seconds while maintaining constant pressure on the point while you monitor the point and slowly return to neutral c) Hold for 90 seconds and return to neutral slowly d) Hold for 90 seconds and rapidly return to neutral e) Compress for three to five seconds and return to neutral 9) A 21-year-old male is weeding the garden and is bent over for an extended period of time. When his lumbar musculature is in a strain position, which of the following is true? a) There is only mild tension in the strained muscle b) The strained muscle has less proprioceptor activity c) The proprioceptor activity in both muscles is an abnormal physiologic response d) The antagonist muscle is in a strain position e) The antagonist muscle has less proprioceptor activity 10) Kuchera and Kuchera identify approximately how many counterstrain tender points? a) 48 b) 72 c) 112 d) 146 e) 214 11) Which of the following describes counterstrain osteopathic manipulative treatment? a) Direct and active b) Direct and passive c) Indirect and active d) Indirect and passive 12) Which of the following describes HVLA osteopathic manipulative treatment? a) Direct and active b) Direct and passive c) Indirect and active d) Indirect and passive 13) Which of the following describes muscle energy osteopathic manipulative treatment? a) Direct and active b) Direct and passive c) Indirect and active

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d) Indirect and passive 14) Which of the following describes soft tissue (e.g. perpendicular stretch) osteopathic manipulative treatment? a) Direct and active b) Direct and passive c) Indirect and active d) Indirect and passive Matching: a) Counterstrain tender point b) Travell trigger point c) Chapman point 15.1) Pain is pinpoint, sharp, and exquisitely tender 15.2) A hyper-irritable spot, usually within a taut band of skeletal muscle 15.3) Used in the treatment of somatic dysfunction 15.4) Compression can cause referred pain 15.5) Treated with circular pressure for 10-30 seconds 15.6) Used in the differential diagnosis of visceral disease 15.7) Treated generally by rounding around the point and holding for 90 seconds 15.8) Treatment is to reduce adverse sympathetic influence on a particular organ 15.9) used in the treatment of somatic dysfunction and/or viscerosomatic dysfunction 16) Licensing of osteopathic physicians in California was halted an d M.D. degrees were granted by the former Osteopathic College to nearly ne arly 6500 D.O.s for a $65 fee. The Los Angeles College of Osteopathic Physicians and Surgeons becomes an allopathic medical school, later affiliated with the University of California system. All this happened over several months in which years? a) 1960-61 b) 1961-62 c) 1962-63 d) 1963-64 e) 1964-65 17) In a dysfunctional joint that is stretched, the strained muscle will show ____ proprioception and the antagonistic muscle will show ___ _ proprioception activity. a) Increased; Greatly increased b) Increased; Greatly decreased c) Decreased; Greatly increased d) Decreased; Greatly decreased 18) If a patient reports a counterstrain tender point as 10 out of 10 on o n a pain scale, what new pain scale value (out of 10) would indicate a successful treatment? a) 7 or less b) 7 or more c) 3 or less d) 3 or more OPP #18 – Lumbar Counterstrain 1) What nerve innervates the latissimus dorsi muscle? a) Long thoracic nerve b) Spinal accessory nerve c) Thoracodorsal nerve d) Subscapular nerve

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2) Which of the following does NOT describe a counterstrain tender point? a) Tense b) Edematous c) Discrete d) Radiate pain e) Small, tender 3) How long are rib tender points p oints held when treating with counterstrain? a) 3-5 seconds b) 30 seconds c) 60 seconds d) 90 seconds e) 120 seconds 4) Which of the following is a contraindication for counterstrain techniques? a) Bone spur b) Fused vertebrae c) Systemic infection or cancer d) Muscle cramps e) Previous stroke or heart attack 5) What anterior lumbar tender point(s) are located on the anterior inferior iliac spine (AIIS)? a) AL1 b) AL5 c) AL1 & AL5 d) AL2 – AL4 e) AL1 – AL5 6) Which of the following posterior tender point(s) is treated with the patient prone, their ipsilateral leg bent, and their leg dropped off the table? a) PL1-PL4 b) PL4 c) UPL5 d) LPL5 e) UPL5 & LPL5 7) Which of the following tender points is treated with the patient supine, ankles/feet hooked together, and legs externally rotated (“frog leg”)? a) Iliacus b) AL1 & AL5 c) UPL5 d) LPL5 e) PL1-PL4 8) Which of the following is most associated with a positive vertebral step-off sign? a) Spondylosis b) Spondylolysis c) Spondylolisthesis 9) Which of the following is associated with degenerative disc disease? a) Spondylosis b) Spondylolysis

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25Mar2009

c) Spondylolisthesis 10) What spondylolisthesis grade signifies >50% displacement and is the point at which surgery should be considered due to possible neurological damage? a) Grade I b) Grade II c) Grade III d) Grade IV 11) A key non-neutral somatic dysfunction at L1 or o r L2 that is rotated left and side-bent left (RLSL) would be caused by a ____ psoas spasm, which couples with a ____ piriformis spasm, causing a ____ oblique axis of the sacrum. a) Left; Left; Left b) Left; Right; Left c) Right; Right; Right d) Right; Left; Right 12) What dermatome most corresponds to the lateral thigh? a) L1 b) L2 c) L3 d) L4 e) L5 13) What dermatome most corresponds to the posterior thigh and calf? a) S5 b) S4 c) S3 d) S2 e) S1 14) Injury to what nerve root would have pain along the lateral thigh and shin, numbness over the knee, motor weakness with quadriceps extension, and a decreased patellar reflex? a) L3 b) L4 c) L5 d) S1 e) S2 15) What nerve root is associated with the Achilles reflex? a) L3 b) L4 c) L5 d) S1 e) S2 16) The straight leg raising test is used to check che ck for compression of what nerve? a) Femoral b) Obturator c) Sciatic d) Superior gluteal e) Inferior gluteal

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25Mar2009

17) The Thomas Test checks for spasm of what muscle(s)? a) Quadratus lumborum b) Quadriceps c) Hamstrings d) Iliopsoas e) Gluteus medius 18) The Trendelenberg Test checks check s for strength of what muscle(s)? a) Quadratus lumborum b) Quadriceps c) Hamstrings d) Iliopsoas e) Gluteus medius OPP #19 – Cervical Counterstrain 1) What is the role of the suboccipital articulation a rticulation (OA & AA joints) in spinal compensation? a) Promotes monocular vision b) Allows for nystagmus c) Keeps eyes level d) Inhibits the oculocervical (oculogyric) reflex e) Keeps the sacrum level 2) A unilateral cervical muscle spasm can cause unilateral rotation of what bone, leading to benign cervical vertigo? a) Parietal bone b) Sphenoid bone c) Temporal bone d) Occipital bone e) Frontal bone 3) Which of the following describes how to treat a posterior cervical tender point at the level of C3 (PC3) with counterstrain? a) Flexion, side-bend away, rotate away (fSARA) b) Extension, side-bend away, rotate away (eSARA) c) Flexion, side-bend toward, rotate away (fSTAR) d) Extension, side-bend toward, rotate away (eSTAR) 4) Which of the following describes how to treat an anterior cervical tender point at the level of C7 (AC7) with counterstrain? a) Flexion, side-bend away, rotate away (fSARA) b) Extension, side-bend away, rotate away (eSARA) c) Flexion, side-bend toward, rotate away (fSTAR) d) Extension, side-bend toward, rotate away (eSTAR) 5) Which of the following midline cervical tender points is treated with extension? a) PC1 b) PC7 c) AC1 d) AC5 e) AC8

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6) Which of the following describes how to treat a posterior cervical tender point at the level of C5 (PC5) with counsterstrain? a) Flexion, side-bend away, rotate away (fSARA) b) Extension, side-bend away, rotate away (eSARA) c) Flexion, side-bend toward, rotate away (fSTAR) d) Extension, side-bend toward, rotate away (eSTAR) 7) Which cervical counterstrain tender point is found within the trapezius muscle? a) AC7 b) AC8 c) PC7 d) PC8 8) Which of the following describes the location of the anterior cervical tender points at the level of C7 and C8? a) AC7 and AC8 lie on top of each other b) AC7 is located medial to AC8 c) AC8 is located medial to AC7 d) AC7 is located caudad to AC8 e) AC8 is located caudad to AC7 James Lamberg

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Osteopathic Principles & Practice – Part 2 AnswerKey OPP #1 1) F 2) B 3) D 4) A 5) C 6) C 7) B 8) D 9) C 10) A 11) E 12) B 13) E 14) B 15) D 16) F 17) A 18) C 19) A 20) B 21) C 22) E 23) B OPP #2 1) E 2) C 3) B 4) D 5) C 6) B 7) D 8) A 9) D 10) C 11) A 12) D 13) B 14) B 15) E 16) A OPP #3 1) E

2) A 3) B 4) C 5) E 6) D 7) C 8) A 9) D 10) A 11) B 12) C 13) C 14) C 15) D 16) A 17) B 18) D 19) A 20) C 21) B 22) B 23) A 24) A 25) A 26) B 27) C 28) D 29) A 30) B 31) E OPP #4 1) C 2) D 3) A 4) D 5) D 6) E 7) B 8) A 9) B 10) B 11) E 12) D 13) C 14) A

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15) B 16) C 17) B OPP #5 1) D 2) C 3) E 4) A 5) B 6) C 7) A 8) E 9) D 10) B 11) A 12) C 13) C 14) C 15) D 16) D 17) E 18) C 19) D 20) A 21) B 22) C 23) B 24) C 25) A 26) B 27) A 28) D 29) B 30) E 31) A 32) C 33) D 34) C 35) D 36) E 37) B 38) C 39) E 40) A 41) F

25Mar2009 42) B 43) A 44) D 45) C 46) E OPP #6 1) D 2) D 3) A 4) E 5) B 6) C 7) D 8) D 9) C 10) D 11) E 12) A 13) A 14) E 15) C 16) B 17) D 18) C 19) E 20) D 21) D 22) B 23) A 24) C OPP #7 1) E 2) B 3) D 4) C 5) E 6) B 7) C 8) C 9) E 10) B

2) C 3) B 4) D 5) E 6) A 7) C 8) C OPP #9 1) B 2) D 3) D 4) B 5) E 6) B 7) C 8) A 9) C 10) C 11) E 12) D 13) C OPP #10 1) D 2) C 3) B 4) E 5) A 6) A 7) A 8) D OPP #11 1) C 2) C 3) B 4) D 5) B 6) B 7) E 8) A 9) C 10) A

OPP #8 1) D

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Osteopathic Principles & Practice – Part 2 OPP #12 1) D 2) E 3) B 4) C 5) A 6) B 7) B 8) D 9) E 10) E 11) D 12) A 13) D 14) B 15) C 16) F 17) B 18) C OPP #13 1) A 2) C 3) C 4) A 5) D 6) A 7) D OPP #14 1) D 2) C 3) C 4) B 5) B 6) C 7) A 8) B 9) D 10) B 11) B OPP #15 1) D 2) A 3) C

4) C 5) E OPP #16 1) B 2) D 3) B 4) D 5) B 6) E 7) A 8) D 9) A 10) C 11) B 12) B 13) C 14) D 15) A 16) A 17) C 18) B OPP #17 1) C 2) B 3.1) A 3.2) B 3.3) D 3.4) D 3.5) A 3.6) B 3.7) B 3.8) A 3.9) C 4) C 5) D 6) B 7) E 8.1) B 8.2) A 8.3) A 8.4) A 8.5) B 8.6) C 9) E

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10) D 11) D 12) B 13) A 14) B 15.1) C 15.2) B 15.3) A 15.4) B 15.5) C 15.6) C 15.7) A 15.8) C 15.9) A 16) B 17) A 18) C

25Mar2009 8) C

OPP #18 1) C 2) D 3) E 4) C 5) D 6) D 7) A 8) C 9) A 10) C 11) B 12) B 13) D 14) B 15) D 16) C 17) D 18) E OPP #19 1) C 2) C 3) C 4) C 5) B 6) B 7) D

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Quiz Osteopathic Part 2 of 4

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